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Glaucoma #Glaucoma #Diabetic Retinopathy #Ophthalmology #GlobalHealth #Vision

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Glaucoma Eye

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What is Glaucoma?

Glaucoma is a group of eye conditions that damage the optic nerve and the leading cause of irreversible blindness in the world. In 2020, about 80 million people worldwide were living with glaucoma, and this number is expected to increase to over 111 million by 2040. In the United States, more than 3 million people are affected with glaucoma. African Americans are at a higher risk of developing glaucoma compared to people of European ancestry. 

The optic nerve is a bundle of nerve fibers that carries information from the eye to the brain. Damage to the optic nerve can lead to vision loss or complete blindness. Symptoms can start slowly and may not be noticeable until there is vision loss. According to the BrightFocus Foundation, glaucoma is 15 times more likely to cause blindness in African Americans compared to Caucasians. In addition to this higher frequency, glaucoma often occurs earlier in life in African Americans — on average, about 10 years earlier than in other ethnic populations.The only way to find out if you have glaucoma is to get a comprehensive, dilated eye exam.  

There is no cure for glaucoma, but early detection and treatment can often help to minimize damage and protect your vision. 

After cataracts, glaucoma is the leading cause of blindness in African Americans. Half of those with glaucoma don't know they have it.
  • Glaucoma strikes earlier and progresses faster in African Americans.
  • The risk for glaucoma is 20% higher if glaucoma is in your family.

Patient Glaucoma Stories

Types of Glaucoma

The most common type of glaucoma is Primary Open-Angle Glaucoma (POAG) and affects more than 2.7 million of Americans, 40 years and older. POAG is 3 to 4 times more common in African Americans. POAG is characterized by partial blockage of tissue called the trabecular meshwork which causes a buildup of fluid (known as aqueous humor) leading to increased pressure in the eye. This pressure can damage the optic nerve and happen so slowly that vision loss may occur before you know there is a problem. 

Other types of glaucoma include close-angle glaucoma (REF), normal-tension glaucoma (REF) and pigmentary glaucoma (REF). Closed-angle glaucoma may occur suddenly (acute closed-angle glaucoma) or gradually (chronic closed-angle glaucoma). Juvenile or congenital glaucoma (REF) is usually detected at birth or the first few years of life and may be related to underlying medical conditions. 

Three Generations

Risk Factors & Symptoms

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Treatments

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Research and Clinical Trails

Eye Test

Screening Diagnosis

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Causes

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Patient Support

 
 

Risk Factors & Symptoms

AFRICAN AMERICANS ARE AT A HIGHER RISK OF GLAUCOMA.

Risk Factors

Risk factors established by the American Academy of Ophthamology (AAO) include:

  • 60 years or older

  • African race or Latino/Hispanic ethnicity

  • Persistent elevated IOP

  • Family history of glaucoma

  • Low ocular perfusion pressure

  • Type 2 diabetes mellitus

  • Myopia or nearsightedness

  • Thin central cornea

 

African Americans belonging to any of the following risk groups have a 5-times greater risk of developing glaucoma:

  • 40 years or older

  • Extreme nearsightedness

  • Diabetes

  • Hypertension

  • Prolonged steroid use​

Symptoms

Open-angle glaucoma

  • Patchy blind spots in your side (peripheral) or central vision, frequently in both eyes

  • Tunnel vision in the advanced stage

Acute angle-closure glaucoma

  • Severe headache

  • Eye pain

  • Nausea and vomiting

  • Blurred vision

  • Halos around lights

  • Eye redness

African Americans and Latino/Hispanic Americans should get a thorough eye exam for glaucoma every 1 to 2 years after age 35.

Glaucoma is the result of damage to the optic nerve. As this nerve gradually deteriorates, blind spots develop in your visual field. For reasons that doctors don't fully understand, this nerve damage is usually related to increased pressure in the eye.
 

Elevated eye pressure is due to a buildup of a fluid (aqueous humor) that flows throughout the inside of your eye. This internal fluid normally drains out through a tissue called the trabecular meshwork at the angle where the iris and cornea meet. When fluid is overproduced or the drainage system doesn't work properly, the fluid can't flow out at its normal rate and eye pressure increases.

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Screening and Diagnosis

Screening​ and Diagnosis

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A thorough dilated eye exam including a visual field test every 1 to 2 years or as directed by a doctor is recommended for people who fall into one of the higher risk categories. African Americans and Latino/Hispanic Americans should get a thorough eye exam for glaucoma every 1 to 2 years after age 35.

A diagnosis of primary open-angle glaucoma (POAG) is established by the presence of a consistently elevated intraocular pressure (IOP) or a suspicious optic nerve, retinal nerve fiber layer (RNFL), or visual field, in one or both eyes. Eye pressure is measured in millimeters of mercury (mm Hg). Normal eye pressure ranges from 12-22 mm Hg, and eye pressure of greater than 22 mm Hg is considered higher than normal. Higher than normal IOP is referred to as ocular hypertension and may be present if patients have glaucoma, use medication (e.g. steroids) or have recently undergone eye surgery.

A comprehensive eye exam performed by an optometrist or ophthalmologist is needed to diagnose and determine the appropriate treatment for glaucoma. There are several tests to detect glaucoma including:

  • Visual acuity test

  • Visual field test

  • Dilated eye exam

  • Measuring eye pressure, i.e, tonometry

  • Measure corneal thickness, i.e., pachymetry

  • Examine the back of the eye (i.e.,ophthalmoscopy) including the retina, choroid and blood vessels

  • Examine the front of the eye (i.e., gonioscopy) including the cornea and iris

  • Optic nerve imaging including computer-based imaging and stereoscopic photography

 

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Treatment

The decision to treat a patient with POAG depends on the IOP level and other associated risk factors, or evidence of change of the optic nerve, RNFL, or visual field. In the Ocular Hypertension Treatment Study (OHTS), more than 90% of patients with untreated ocular hypertension did not progress to glaucoma over 5 years, but treatment to lower IOP reduced the risk of developing POAG from 9.5% to 4.5%. A reasonable target for IOP reduction in a patient being treated for POAG is 20% based on the OHTS. If left untreated, glaucoma will eventually cause blindness. Even with treatment, about 15% of people with glaucoma become blind in at least one eye within 20 years.

Because vision loss due to glaucoma can't be recovered, it's important to have regular eye exams that include measurements of your eye pressure so a diagnosis can be made in its early stages and treated appropriately. If glaucoma is recognized early, vision loss can be slowed or prevented. If you have glaucoma, you'll generally need treatment for the rest of your life.

It is recommended to seek immediate medical attention if you experience signs or symptoms of acute angle-closure glaucoma as damage can happen very quickly.

There are many treatment options available to treat glaucoma and depend on the type of glaucoma.

  • Open-angle glaucoma is most often treated with combinations of eye drops, laser trabeculoplasty, and microsurgery. Doctors tend to start with medications, but early laser surgery or microsurgery could work better for some people.

  • Acute angle-closure glaucoma is usually treated with a laser procedure.

  • Infant or congenital glaucoma is usually treated with surgery because the cause is a problem with your drainage system.

Some types of eye drops work by helping fluid drain from your eye, which lowers eye pressure. Examples include: 

  • Prostaglandins 

  • Rho kinase inhibitor

  • Nitric oxides,

  • Miotic or cholinergic agents

Other types of eye drops work by lowering the amount of fluid your eye makes. Examples include: 

  • Alpha-adrenergic agonists

  • Beta blockers 

  • Carbonic anhydrase inhibitors

 

 

Glaucoma is the leading cause of irreversible vision loss worldwide [1]. Primary open-angle glaucoma (POAG), the most common form of the disease, accounts for the majority (74%) of glaucoma cases [1]. In 2013, more than 44 million individuals were affected by POAG, with this number predicted to increase to between 53 million [2] and 58 million by 2020 [1]. This increased disease burden emphasizes the importance of identifying factors that affect POAG prevalence. Demographic variables, known as non-modifiable or inherent determinants of disease, can be important in identifying high-risk groups. Age is a strongly established risk factor for POAG, with prevalence in US adults increasing from 0.6% at ages 40–49 to 8.3% at age 80 or older [3]. Race is also a strong risk factor, with African Americans four to five times more likely to have glaucoma than European Americans [4]. However, there is little agreement on the role of gender in the development and severity of POAG.

POAGG - largest genetic study of POAG in an African American population recruited in a single city. 

 

Age, BMI, IOP, and family history, that men were more likely to have POAG than women 

 

If so, during and after menopause, women may have the same risk of POAG as men, due to decrease of estrogen-meditated protection.

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 A Patients Story

Patients give their stories of discovering Glaucoma, their retreatments and their life changes due to a Glaucoma diagonosis 

A Patients Story

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Research and Clinical Trials

The Primary Open-Angle African American Glaucoma Genetics (POAAGG) recruited and enrolled 4828 African American participants with POAG. This is the largest genetic study of POAG in an African American population recruited in a single city.

One of the key objectives of this study was to evaluate the relationship between gender and risk of POAG in this study population. Results indicate that African American males  were 1.64 times more likely to have POAG than females, after adjusting for age differences, systemic diseases, and BMI. POAG cases also had more systemic hypertension, less diabetes, and lower BMI than controls. Additionally, during and after menopause, women may have the same risk of POAG as men, due to decrease of estrogen-meditated protection.However, the data did not suggest that gender is associated with the development and severity of POAG. Details regarding the POAAGG study can be found here.

 

The American Academy of Ophthamology (AAO) developed and manages the IRIS (Intelligent Research in Sight) Registry (REF), the first national comprehensive eye disease clinical registry. The 2019 dashboard (REF) includes a summary of the different types and severity of glaucoma by race, ethnicity and other types of demographic data based on real world data.

 

More information regarding clinical research in glaucoma can be found here.

Prevention

Image by Harpreet Singh
Image by Harpreet Singh

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These self-care steps can help you detect glaucoma in its early stages, which is important in preventing vision loss or slowing its progress.

  • Get regular dilated eye examinations. Regular comprehensive eye exams can help detect glaucoma in its early stages, before significant damage occurs. As a general rule, the American Academy of Ophthalmology recommends having a comprehensive eye exam every five to 10 years if you're under 40 years old; every two to four years if you're 40 to 54 years old; every one to three years if you're 55 to 64 years old; and every one to two years if you're older than 65. If you're at risk of glaucoma, you'll need more frequent screening. Ask your doctor to recommend the right screening schedule for you.

  • Know your family's eye health history. Glaucoma tends to run in families. If you're at increased risk, you may need more frequent screening.

  • Exercise safely. Regular, moderate exercise may help prevent glaucoma by reducing eye pressure. Talk with your doctor about an appropriate exercise program.

  • Take prescribed eyedrops regularly. Glaucoma eyedrops can significantly reduce the risk that high eye pressure will progress to glaucoma. To be effective, eyedrops prescribed by your doctor need to be used regularly even if you have no symptoms.

  • Wear eye protection. Serious eye injuries can lead to glaucoma. Wear eye protection when using power tools or playing high-speed racket sports in enclosed courts.

 

Patient Support

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Running Pair

There are two sides of glaucoma research and support: finding the cure, and helping people afflicted with the disease lead full and healthy lives.

 

People suffering from diminished vision and blindness can get the support they need from people who understand that glaucoma management is a lifelong pursuit, by talking to counselors and peers.

Local Support Groups

There are many support groups for people with glaucoma. To find a group that meets in person, check with hospitals and eye care centers in your area.

Support Groups Online

There are a few active online glaucoma support groups.

Facebook Groups

The Glaucoma Eyes group and the Glaucoma Support group let people with glaucoma share their stories and offer each other support.

The Glaucoma Eyes group on Facebook is a private support group for glaucoma patients, glaucoma suspects, glaucoma family members and friends of those with glaucoma. Support is based on personal experiences relating to care of the mental, physical and emotional aspects of managing glaucoma.

The Glaucoma Support group on Facebook is a private group where glaucoma patients can exchange notes and websites, offer each other support, and help to increase glaucoma awareness.

If you would like to recommend an online support group, please let us know.

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